Medical Prior Authorization Specialist

Onco360•Scottsdale, AZ

7h•$22•Onsite

About The Position

The Medical Prior Authorization Specialist will ensure patients receive medications that requires pre-authorization from insurance carriers by reviewing orders and clinical documentation received and investigate/identify authorization requirements needed to obtain medication coverage. They will ensure accurate insurance benefit documentation is made for specific IV and infused therapy orders.

Requirements

High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification
1+ years’ Prior Authorization experience
Medicare and Medical insurance and benefit verification, medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, coordination of benefits, Understanding Medicare Parts A, B, C, and D, as well as relevant laws and guidelines, NDC medication billing, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, basic math and analytical skills, Intermediate typing/keyboarding skills.
Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skills

Nice To Haves

Associate degree or equivalent program from a 2-year program or technical school, Certified Pharmacy Technician (PTCB), Specialty pharmacy experience
3+ years Specialty Pharmacy, Medical, and/or Infusion prior authorization experience
Specialty Pharmacy experience, Medicare Billing Experience, Medical Authorization experience
Registration with Board of Pharmacy as required by state law or Certified Pharmacy Technician (PTCB)

Responsibilities

Manage prior authorization requests and appeals with insurance carriers as well as collaborating with physicians, pharmacists, and other departments.
Develop expertise and maintain in-depth knowledge of insurance authorization policies, coverage terms, and complex authorization and appeal process. Identify the appropriate clinical records and submit the authorization request to the insurance company based on plan requirements for approval.
Maintain accurate documentation of authorization details and proactively monitor and renew expiring authorizations.
Facilitate process for requesting medical authorizations, completing appeals for applicable commercial, Medicaid, and Medicare, or facility medication claims.
Will require reimbursement experience for oncology and/or specialty injected/infused products in a buy and bill setting across all sites of care.
Ensure HIPAA compliance while handling sensitive patient information.
Communicate succinctly and professionally both verbally and through written correspondence with Physician offices, nurses, insurance companies and patients as needed.
Exhibits a positive, courteous, respectful, and helpful attitude towards patients, team members, payers, and management. Contributes team effort by accomplishing related tasks as needed and other duties as assigned.
Knowledge of payer landscape including state, federal, private third-party reimbursement issues, methodologies, and policies for physician administered products
Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.